Systems Supporting Vulnerable Citizens
On 29th January 2020 we hosted the National Leadership Forum, bringing together 400 public service leaders for discussions about how we are Working Together; as a system.
In the spirit of sharing the insights from the day, we have written blog posts describing the content of the discussions.
It is vital that our public services are joined up, especially for our most vulnerable — “you should only have to tell us about your trauma once”. Simple, right? Yes, but it’s the simplest ideas that can be most difficult to put into practice. This sort of join-up is complex, needs new relationships across organisational and sectoral silos, and asks leaders to hold their nerve.
The National Leadership Forum panel, chaired by Peter Wanless CB (National Leadership Centre Advisory Board Member and Chief Executive of the National Society for the Prevention of Cruelty to Children) facilitated a discussion about the practicalities of developing the public service systems that support vulnerable citizens. Peter was joined by:
● Chief Constable Jo Farrell, Durham Constabulary, who is responsible for the design and implementation of a randomised control trial for deferred prosecution.
● Stephen Walker, Director of Children and Family Services at Leeds City Council, who guided the transformation of Leeds into an outstanding city for children.
● Kathryn Glass, Quality Support Practitioner, Stockport NHS Foundation Trust, who helped create and implement a Veteran’s Passport for health and social care.
Individual-focused
Individuals with lived experience must be at the heart of public service design and implementation. This can be described in many ways, from user-focused to human-centred design, but all approaches advocate reaching out for, and bringing in, the perspectives of those at the sharp end of public service delivery. “It’s about amplifying someone’s voice” and “working for the good” of that person, explained the panelists.
Stephen shared how Leeds City Council put this in to practice in 2009, when they were inspected and deemed ‘not safe’ for children. Referrals to child services had increased by 30%, the number of children subjected to a Child Protection Plan had almost doubled, and Leeds had the second highest number of looked after children in the country. Leeds City Council decided to take a systems approach, where physical regeneration of the city was delivered through social regeneration of its public. They had realised that to be a successful city, they had to be successful for children. Consequently, everything the Council did was framed by the question “What’s it like to be a child in Leeds?” The city is now deemed to be an ‘outstanding’ place for children, and is one of just two cities in Europe that has begun to reduce childhood obesity.
Working with individuals who have the lived experience of the problem is fundamental. All the panelists agreed that “a desire to listen” was needed to put this into practice. They explained the importance of going to those with experience of the service (users, clients or customers, their support network and public facing staff) to hear and see the challenges they face. Our panelists found it helpful to ask these individuals questions like “what do you want?” and “what should ‘good’ look like?” Ultimately, they all agreed public service was about “making a difference to people’s lives”.
Kathryn shared her experience of implementing the Veterans’ Passport for health and social care. The passport only requires veterans to tell their story and medical history — often a traumatic experience — once, while enabling public services to deliver a joined-up treatment plan. Kathryn emphaised that it is the patient, client, victim, child or citizen who is the expert, “not us” as leaders of public services.
Outcomes, not process
It is easy to say something was successful when “we did the process properly”. Service delivery can be too process-focused, and the panelists highlighted how this may need to change. It is the outcomes the process achieves, not the implementation of process, that improves people’s lives.
Jo put this into context with Durham’s Check Point Critical Pathways. This a programme that defers prosecution to help those who did not receive the prevention support they needed or made one, unwise decision. This is not a soft option — these people undertake a support programme before they interact with the criminal justice system. Delivering this requires a significant deviation from standard process, but a Randomised Control Trial demonstrated the extent to which it improves outcomes for the public (not just those who commited the crime).
The panelists explained how shifting their focus to outcomes needed them to recognise and voice that what they were doing wasn’t working. Ultimately, it’s about doing the right thing by the public and delivering better public services.
Let us know your thoughts on the question on user engagement or any other issues around leadership, systems working and collaboration in public services. Get in touch by email on NLC@CabinetOffice.gov.uk or on Twitter @NLC_HQ
